Will Your Breasts Ever Be the Same After Pregnancy?

"They're gearing up to produce enough milk for a newborn baby," says Tanmoy Mukherjee, MD, a reproductive endocrinologist at Mount Sinai School of Medicine in New York City. When you're pregnant, your body has very high levels of estrogen and progesterone, hormones that stimulate your breasts' milk glands and milk ducts, respectively. The result of all this can be a big change in bra size, but growth usually slows or stops at the end of the first trimester. Your best strategy? Go to a department store or old-fashioned bra shop and get fitted for your new size.

My breasts are big already. Can I do anything to slow the growth?

"Keeping your weight gain in check might ensure that your breasts won't get even bigger, but there's nothing you can do about the hormones," says Shari Brasner, MD, an ob-gyn and author of Advice from a Pregnant Obstetrician (Hyperion). No special foods, massages, exercises, or creams affect breast growth during pregnancy, so spend your money on a good supportive bra instead. If your bust size no longer allows for standard bras, check out Lane Bryant (lanebryant.com) for beautiful bras in larger sizes.

Why are my nipples so bumpy and dark?

Blame it on the hormones again. As early as the first trimester, the nipple sticks out more and Montgomery's glands (those tiny bumps surrounding your areola) become more prominent in preparation for nursing. Your darkening nipples are also the result of hormones. They stimulate pigment-producing cells, so expect the nipple and areola to get darker, particularly if you already have a deep skin tone. Fortunately, within a few months postpartum, most nipples return to their original appearance.

Can I avoid getting stretch marks on my breasts?

"Choose different parents," quips dermatologist Barbara R. Reed, MD, founder of the Denver Skin Clinic. "Whether or not you get them depends on heredity." Stretch marks occur when the collagen and elastin in your skin stretch beyond the point of snapping back; if you inherited skin that has a tendency to lose its elasticity when stretched, you're more likely to develop those angry-looking red or purple lines. Though there are creams that promise to prevent them, don't expect miracles. They'll keep your skin soft, and that's about it. Doctors give mixed reviews to laser treatments that target the redness in stretch marks. Some say they make a difference; others aren't so sure about the pricey procedure. "In my experience, laser treatments involve three to five sessions, and they're not that effective," says Rod Rohrich, MD, president of the American College of Plastic and Reconstructive Surgeons.

While there's no surefire treatment for stretch marks, watching your weight gain will help prevent them from looking their worst. And here's one bit of good news: Several months after the baby is born, the marks will fade to a pale silvery color.

My breasts were kind of asymmetrical before I got pregnant. Now it seems that they're worse. Why?

According to Dr. Brasner, "Breasts are incredibly sensitive to hormones." If you're lopsided to begin with, the smaller side will be less receptive to hormones because there's less breast tissue, so both breasts won't grow at the same rate during pregnancy. In addition, if a woman with equal-sized breasts has had surgery on one, the scarred breast may also be less receptive to pregnancy hormones.

Is there anything I can do to prevent or control sagging?

There's not a lot you can do to control sagging (besides keeping your weight stable and wearing a supportive bra). Whether you end up much the same or plagued with ptosis -- a fancy medical word for that rock-in-the-sock look -- how you wind up is really the luck of the draw, determined by factors such as heredity, weight gain, and how big your breasts got while you were pregnant. As breast specialist Susan Love, MD, summarizes: "Lots of women end up smaller, some end up bigger, and a lucky few stay the same."

True, there are many creams and tonics that promise to perk up your bust, but doctors say save your cash. You feel some surface tightening from ingredients such as seaweed, but within minutes or hours the effect is gone. "Putting a cream or lotion on the outside of your breast won't perk up what's underneath," says Dr. Reed. And because your chest muscles rest on top of your chest, not underneath it, exercises won't help either.

I'm breastfeeding, and my breasts are achy. Why, and what should I do?

Your breasts are likely engorged, which means they're practically overflowing with milk. The simplest solution is pumping your milk or nursing more often. Unfortunately, that's not always possible. Cupping an ice pack around the sore breast can help relieve the pain. So can chilled cabbage leaves: For breast-shaped ice packs, put a head of cabbage into the fridge or freezer. After it's sufficiently cooled, "peel off a leaf and put it in your bra," says Carol Huotari, manager of La Leche League International's Center for Breastfeeding Information.

I heard underwire bras interfere with breastfeeding. True?

Yes. Your milk ducts extend down to your rib cage. An underwire can obstruct them and interfere with milk production. Plus, the wires may dig into your chest as your breasts change for nursing. Fortunately, there are wireless supportive bras for nursing moms. Lalecheleague.org has a great list of such resources.

My nipples are sore, cracked, and bleeding from nursing. Help!

Carol Huotari recommends Lansinoh, a soothing lanolin ointment you can apply directly to your nipples and don't have to wash off before your baby nurses. Some soreness is normal in the beginning, but if it continues for more than a week or two, it may be an indication that your baby hasn't latched on correctly. A poor latch means that your baby may not be getting as much milk as she needs, which could compromise your milk production and keep your nipples in rough shape. Call in a lactation consultant, who can help you correct your baby's latch -- and heal your nipples -- through exercises and nursing techniques.

I'm nursing, and I have a hard, painful red spot on my breast. What is it and why is it there?

Your milk is an ideal medium for growing bacteria -- and your baby's mouth is full of germs. Add tiny breaks in your skin caused by sucking, and you can end up with lactational mastitis, an extremely painful bacterial breast infection. You'll know it if you have it: The infected area gets red, hot, and swollen, and is accompanied by a fever and flu-like symptoms. Your doctor will likely prescribe an oral antibiotic that's safe for nursing mothers, tell you to frequently apply warm compresses, and encourage you to continue breastfeeding. Sometimes, mastitis can pave the way for a breast abscess -- a sore, pus-filled lump in the breast that sometimes requires a needle aspiration or surgery to remove infected pus.

To avoid these problems, nurse and pump consistently to keep your milk flowing freely -- a blocked duct is usually where mastitis starts. In between nursing sessions, wash and rinse your nipples to safeguard against bacteria.

Robin McGavin is a beauty writer based in New York City.

Originally published in American Baby magazine, April 2004.

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